Practical Exercise Guidelines After ACL Reconstruction

How to Use This Guide

This workout guide is meant to help people safely and gradually get back to working out after having ACL repair. Exercises are broken up into phases, and you should only go on to the next step when your strength, movement quality, and symptom response allow it.
Studies consistently demonstrate that criteria-based progression yields superior results and reduced re-injury rates compared to time-based therapy alone.(Grindem et al., 2016)

Core Safety and Coaching Principles

Before and during each workout, you should:

  • Not feel pain during or after the workout;
  • Not have more swelling in your knees within 24 hours;
  • Keep your technique under control even when you’re tired;
  • Gradually and planned increase the load;
  • Make sure the exercises are specific to the sport;
    Poor movement quality and too much tiredness have been found to increase the risk of injury and pressure on the ACL transplant.(Hewett et al., 2005)

Stage 1: Foundational Strength and Movement Control

AIM

To build up the strength in the lower limbs, gain back your confidence, and learn how to move safely.

Exercise Focus

These exercises include:

  • sit-to-stand;
  • bodyweight squats;
  • step-ups and step-downs;
  • hamstring curls;
  • glute bridges
  • hamstring curls.

Coaching Cues

  • Knees lined up with toes
  • Weight evenly spread out
  • Slow, regulated speed

Evidence and Rationale

Strength in the quadriceps, hamstrings, and glutes is important for managing the translation of the anterior tibia and taking stress off the ACL transplant.
After ACL repair, early closed-chain strengthening is thought to be safe and helpful. (Perriman et al., 2018)

Stage 2: Balance and Proprioception Training

AIM

To restore joint position sense and neuromuscular control.

Exercise Focus

  • Single-leg stance
  • Balance board or foam surface training
  • Single-leg reach tasks
  • Catch-and-throw balance drills

Coaching Cues

  • Stable pelvis
  • Upright trunk
  • Avoid inward knee collapse

Evidence and Rationale

An ACL damage causes problems with the signal from the knee that tells the brain where it is in space. Balance and neuromuscular exercises enhance dynamic stability and markedly decrease the risk of subsequent ACL damage.(Dingenen & Gokeler, 2017)

Stage 3: Plyometric Preparation and Landing Mechanics

AIM

To prepare the knee for impact and explosive movements.

Exercise Focus

  • Jump-and-stick drills
  • Double-leg hops
  • Low-level bounding

Coaching Cues

  • Soft, quiet landings
  • Flex hips, knees, and ankles
  • Knees track forward, not inward

Evidence and Rationale

Poor landing mechanics, especially dynamic knee valgus, are closely linked to a higher risk of ACL injuries. Teaching proper landing techniques minimises the pressure on the knee joint and makes mobility more efficient.(Myer et al., 2005)

Stage 4: Running Progression

AIM

To safely bring back linear speed and repeated impact.

PROGRESSION

  1. Walking
  2. Walk–jog intervals
  3. Continuous jogging
  4. Faster straight-line running

Coaching Cues

  • A smooth, even stride
  • No hobbling or stopping
  • Equal push-off from both legs

Evidence and Rationale

Gradual running development enables the muscles and joints get used to heavier weights without hurting them. Returning to jogging too soon has been associated to more oedema and a longer recovery time. (Rambaud et al., 2018)

Stage 5: Agility and Change-of-Direction Training

AIM

To restore control during rapid deceleration and cutting movements.

Exercise Focus

  • Running in a figure-eight shape
  • Side shuffles
  • Planned cutting drills
  • Tasks to slow down

Coaching Cues

  • Lower the centre of gravity before cutting
  • Strong hip engagement
  • Controlled trunk posture

Evidence and Rationale

Most non-contact ACL injuries happen when you cut or slow down. Gradually exposing yourself to these motions can help you regulate your body better and lower your chance of being hurt (Nedergaard et al., 2020)

Stage 6: Sport-Specific Exercise Integration

AIM

To prepare the athlete for real competitive demands.

EXAMPLES

  • Football: sprint-to-cut and kicking exercises
  • Basketball: jump shots and side-to-side shuffles
  • Field sports: workouts for reactive agility

Evidence and Rationale

Most non-contact ACL injuries happen when you cut or slow down. Gradually exposing yourself to these motions can help you regulate your body better and lower your chance of being hurt (Nedergaard et al., 2020)

Exercise Dosage and Load Management

  • Strength: 2–4 sets of 6–12 reps
  • Balance: 30–45 seconds each set
  • Plyometrics: low volume, high quality
  • Enough recovery between sessions

More training volume is less protective than high-quality movement with controllable tiredness. (Van Melick et al., 2016)

Progression and Regression Guidelines

Progress When

  • The quality of movement stays good.
  • No discomfort or swelling
  • Confidence goes up

REgress When

  • Pain or swelling becomes worse
  • Tiredness makes it hard to regulate
  • Fear or doubt shows up